thoracic surgery

During recent years the application of non invasive ventilation (NIV) has emerged as a central component of respiratory failure management, acute and chronic. Although the use of NIV in acute respiratory failure was initially meant to be given in critical care units, it is nowadays natural to provide it in other settings as well, provided that there are the necessary resources and expertise. NIV represents a viable alternative to endotracheal ventilation and despite most data refer to patients with chronic obstructive pulmonary disease; its indications are continuously expanding to cover more clinical scenarios. Randomized controlled studies are needed in order to provide sound evidence regarding optimal patient-ventilator interface, NIV duration and ventilation parameters in thoracic surgery patients.

Schwannomas, known also as neurilemmomas, are considered to be benign in the vast majority of cases. Originating from the schwan cells of the neural sheath of peripheral nerves, they usually develop in the head and neck. Involvement of the brachial plexus is relatively rare, with an incidence of 0.3–0.4/100,000 person per year1. Malignant transformation is extremely uncommon. Patients’ initial symptoms include pain, loss of function, numbness or a progressively growing mass in the supraclavicular region. Neglected cases regarding larger benign tumors may present with monoparesis of an upper limb2. Primary malignant schwannomas of the brachial plexus causing monoplegia are extremely infrequent and to the best of our knowledge very few cases have been published in the international literature.

Nitric oxide (NO) inhalation has been used after mitral valve surgery in attempts to control pulmonary hypertension. The cost of NO therapy in some countries has made its use prohibitive and has led to attempts to use aerosolized nitroglycerin.